Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1 Diseases of the Urinary and...

Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1

Diseases of the Urinary and Reproductive system

Copyright © 2005 by Elsevier Inc. All rights reserved.


Orderly Function of the Urinary System

The urinary tract is responsible for:producing, storing, and excreting urine cleansing the blood of waste products regulating the water, salts, and acids in the

body fluids to ensure homeostasis


The urinary system consists of:

kidneys (2) ureters (2) urinary bladder urethra


Nephrons

About 1 million per kidney Responsible for filtration, reabsorption,

and secretion of urine Transports urine to renal pelvis and then

to ureters


Evaluation of the urinary system

Proper function is usually determined by urinalysis and blood tests.

Normal results demonstrate: proper filtration, absorption, and elimination

of metabolic wasteprecise fluid and electrolyte balance


Symptoms of Urinary Diseases

nausea loss of appetite fever headache and body

ache flank or low back pain

edema decreased urinary

output hypertension pruritus


Acute Glomerulonephritis

Description: inflammation and swelling of the

glomeruli of the kidney can be primary disease of the kidney can develop secondarily to a systemic

disease usually follows a streptococcal bacterial

infection of the throat or skin


Location of the glomerulus in the nephron


Acute Glomerulonephritis (cont’d.)

Symptoms: protein in the urine (proteinuria) edema decreased urine volume blood in urine (hematuria) hypertension (not always present)


Acute Glomerulonephritis (cont’d.)

Treatment: antibiotic therapy (if infection present) rest diuretics for edema and hypertension restricted sodium intake corticosteroids (if immune reaction is

suspected)


Chronic Glomerulonephritis

Description: a slowly progressive, noninfectious

disease that can result in irreversible renal damage and renal failureoften seen in advanced stage kidney

disorders reduces glomerular filtration, which causes

retention of uremic poisons


Chronic Glomerulonephritis (cont’d.)

Symptoms: Initially: no symptoms Midstage:

hypertension hematuria proteinuria oliguria (slight or

infrequent urination) edema

Late stage severe hypertension azotemia (an excess

amount of nitrogen-bearing wastes in blood)


Dialysis

End stage renal disease forces approximately one in every 10,000 people to use dialysis to filter wastes from their blood and urine. Without dialysis, these patients will eventually die.


Hemodialysis

Fistula provides access to blood. Blood is drawn out of the body and

filtered using an artificial kidney (hemodialyzer).

Cleansed blood is returned to the body.


Hemodialysis (cont’d.)


Peritoneal Dialysis

Process uses patient’s own peritoneal membrane as a filtering device.

The dialysate solution passes into peritoneal membrane through permanent catheter.

The solution diffuses existing wastes. Contaminated fluids are drained from

body.


Kidney transplantation

Approximately 10,000 people receive kidney transplants each year in the U.S.

75% are performed on patients with:diabetes adrenal failurehypertensive renal diseaseglomerulonephritis


Kidney transplantation (cont’d.)

Transplantation requires immunosuppressive agents to prevent potential rejection of the organ.


Nephrotic Syndrome (Nephrosis)

affects the lower membrane of the glomerulus

secondary to a number of renal diseases and other systemic disorders

includes a group of symptoms; sometimes referred to as the protein-losing kidney


Nephrotic Syndrome (cont’d.)

Description: A condition caused by excessive loss of

protein in the urine that results in: depressed plasma protein levels increased water and sodium retention increased susceptibility to infection



Symptoms: bloody urine loss of appetite pale skin puffiness around eyes swollen ankles weight gain



Additional symptoms: lethargy/depression Pelvic pain Hypertension Tests can reveal high levels of albumin,

lipids in urine.



Treatment: Dietary intake of protein is adjusted to

glomerular filtration rate (GFR). Sodium is lowered and diuretics used to

control edema. Urine output is monitored. Corticosteriods may help control

proteinuria in some patients.


Nephrotoxic Agents

solvents (methanol, carbon tetrachloride) heavy metals (lead, arsenic, mercury) pesticides antibiotics (kanamycin, gentamicin) nonsteroidal anti-inflammatory drugs (NSAIDs) iodinated radiographic contrast media antineoplastic agents miscellaneous compounds (acetaminophen) poisonous mushrooms


Acute Renal Failure

Description: Acute renal failure (ARF) is

characterized by a sudden and severe reduction in renal function.

ARF qualifies as a clinical emergency because nitrogenous waste products quickly accumulate in blood causing an acute uremic episode.


Acute Renal Failure (cont’d.)

Symptoms:slight or infrequent urination (oliguria)gastrointestinal disturbancesheadachedrowsiness



Etiology:diminished blood flow to kidney intrarenal damage to the kidneymechanical obstruction of urine flowSudden renal failure can lead to death if not

treated promptly.



Treatment: The primary goal is to reverse the

decreased renal function. This may be accomplished by:balancing fluid intake and output initiating a high carbohydrate/low protein

diet to avoid a protein imbalance (called metabolic acidosis)

controlling sodium and potassium intake



Treatment (cont’d.)

Drug therapy may include:antihypertensivesdiureticsanti-infective agentsPrompt treatment can reverse renal failure

and lead to complete recovery.


Chronic Renal Failure

Description: results from the gradual and progressive

loss of nephrons irreversible loss of renal functiongradual onset of waste buildup in blood

(uremia)


Chronic Renal Failure (cont’d.)

hypertension edema arrhythmias muscle

weakness

ulceration of gastrointestinal mucosa

hair and skin changes difficulty breathing

(dyspnea) metabolic acidosis

Symptoms:General—weakness, fatigue, and lethargy (due to anemia)As uremic syndrome worsens:


Hydronephrosis

Description:an abnormal dilation of the renal pelvis

caused by pressure from urine that cannot flow past an obstruction in the urinary tract

chronic condition that can gradually destroy kidneys


Hydronephrosis (cont’d.)



Symptoms:vague backache or diminished urine output

sometimes noticeableoften without pain or symptompresence of infection may bring fever, chills,

blood and/or pus in urine detection is often accidental



Treatment depends upon the cause of the obstruction and duration of condition.surgical intervention possible if discovered

early insertion of nephrostomy tube if surgical

intervention not possible If condition persists for more than 2 months,

kidney function usually ceases.


Diabetic Nephropathy

Description: various renal changes (called

glomerulosclerosis) that result from diabetes

All patients with type 1 diabetes (and many with type 2 diabetes) will eventually develop renal changes.


Diabetic Nephropathy (cont’d.)

Symptoms: urinary retention hypertension nausea protein in urine Urinary tract infections and

pyelonephritis are common complications.


Diabetic Nephropathy (cont’d.)

Treatment includes: glucose management controlling blood pressure infection control balance fluid intake and output customizing for patient needs possible dialysis or kidney transplant as

part of long-term treatment


Polycystic Kidney Disease

Description: slowly progressive, irreversible normal renal tissue replaced with

multiple grape-like cysts


Polycystic Kidney Disease(cont’d.)



Symptoms: lumbar painblood in urine hypertensionprone to renal infection and kidney stones



Diagnosis:urinalysis shows:

blood protein pus

radiographic films show:enlarged kidneys with irregular outlinesspidery appearance


Stress Incontinence

Description: uncontrollable leakage of small amounts

of urine from the bladder during physical exertion or actions that stress the pelvic muscles such as: laughing lifting stretching running


Stress Incontinence (cont’d.)

Etiology: weakening of the pelvic floor muscles

and urethral structure, often attributed to: trauma from childbirthpressure from an existing pregnancyhormonal changes associated with

aging/menopausecertain medicationsobesity


Stress Incontinence (cont’d.)

Treatment:exercises to strengthen pelvic floor musclesestrogen replacement (estrogen cream)drug therapysurgical repaircollagen injections




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Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1 Diseases of the Urinary and...

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